Intervention Description
There are two distinct service models for persons experiencing homelessness that also have issues with mental illness and/or addictions, the treatment first model or the Housing First model. Housing First models utilize a supported housing approach in which consumers start with permanent, independent apartments and providers work with consumers regardless of their symptoms, substance abuse, or whether they participate in formal treatment (Henwood, 2011).
The housing is the treatment or intervention and the treatment is offered as long as the client needs the support.
Although the housing first program posits housing as the treatment, additional services and treatments will often be available within the housing setting. Across the country, teams of providers that include social workers are utilizing housing first programs. These teams provide intensive case management, using an Assertive Community Treatment model to treat participants (Housing, 2012).
These services are designed to help participants maintain their housing while improving their health and mental health status and reducing substance abuse. Theory of Change
Communities across the country have developed, implemented, and refined a wide range of program models and strategies to address chronic homelessness (Caton, 2007).
Some models have been rigorously evaluated and others have been evaluated using less sophisticated methodologies. Some interventions have been implemented widely but little research exists to measure their effectiveness (Canton, 2007).
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There are many debates concerning advantages and disadvantages of mandating community service, however, the practice of compelling adolescents to take part in community service is increasingly common. People seek to understand the relationships between mandatory community service and volunteering. A key distinction between mandated community service and volunteering is the freely-chosen nature of ...
New services for this population developed over the past decade include adaptations or modifications of established evidence-based interventions that were initially designed and tested for stably housed people with serious mental illness while other program innovations have shown promise based on non-experimental evaluations and have yet to be tested experimentally (Caton, 2007).
The many theories surrounding this topic that do exist are beyond the scope of this paper and are centered on qualitative research methods and design. Grounded theory is one, and it is often used because it allows you to seek out and conceptualize the latent social patterns and structures of your area of interest through the process of constant comparison (What is Grounded Theory, 2013).
Grounded Theory is a general research method, which guides you on matters of date collection, where you can use quantitative data or qualitative data of any type and which details strict procedures for data analysis. It is first and foremost a research method (What is Grounded Theory, 2013).
This is especially useful for social justice issues, but when it comes to theory as it is applied to national and community level homeless policies; none as of yet accomplish this. Theoretical explanations of homelessness and policy can be narrowed down to a few modes of thought.
According to the first, individuals are considered responsible for their homelessness and, hence, guilty and blameworthy. Many who question the validity of housing first programs contend that participants must be deemed worthy of such a treatment by showing that they can successfully navigate an independent living environment (Neale, 1997).
The typical stereotypes like the alcoholic on the corner have often been associated with people judged to be homeless for these reasons. The response usually recommended for this form of homelessness is minimalist and involves only the provision of basic accommodation (Neale, 1997).
The second frame of thought maintains that people become homeless because of personal failure for which they cannot be held entirely responsible. These individuals are considered to be more in need of humanitarian assistance (Neale, 1997).
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Homelessness, condition of people who lack regular legal access to housing. Homelessness has been recognized as a significant social problem in the United States since the early 1980 s, when an increase in the number of homeless people was caused by a weak economy and cuts in federal aid for housing and income assistance. Other periods of increased homelessness also have occurred many times in ...
Two other commonly used themes used in theorizing homelessness have related to the concepts of deserving and under deserving. Where homelessness has been seen as a function of structural factors beyond individual control, homeless people have tended to be seen as deserving of assistance (Neale, 1997).
Where individuals have been deemed somehow responsible for their homelessness, they have frequently been considered less worthy of support. Another theoretical framework discussed in tandem with the effectiveness of housing first programs is the concept of human agency.
Human agency is the idea that individuals understand their problems in context with socially acceptable norms (Parsell, 2014).
It recognizes that the homeless population has a unique set of skills and strengths from which they can draw on to navigate their way out of the current situation. People have the capacity to invent new possibilities (Parsell, 2014).
Analysis of the Empirical Literature on Intervention
In the article written by Benjamin Henwood comparing front line providers’ views of housing first programs versus traditional programs, 41 front line service providers in the New York area were studied using a longitudinal qualitative study. 20 providers used the housing first model and the other 21 used the treatment first model. The protocols of the study included a baseline interview during the first month of being housed and a follow up interview either when the client left the program or six months later (Henwood, 2011).
The data was then analyzed using a coding process called Thematic analysis. There were three main conclusions drawn from the study. First, it was found that the housing first model provided a “necessary but not sufficient step toward independent living” (Henwood, 81).
By being housed first their secondary issues started to fall into place.
Clients reported lower problems with substance abuse because they were in stable housing, taking care of part of the hierarchy of needs. A second conclusion from the study was that by providing housing first, it was a useful way to build a solid foundation with the client. Helping them right off the bat helps them help themselves. The final conclusion of the study was that by offering housing first, the notion that a client must be deemed worthy of housing by remaining abstinent through a treatment first model was removed. Another study used in this paper looked specifically at how individuals with substance abuse issues fared in the housing first model versus treatment first. Another longitudinal qualitative study was conducted using 27 housing first clients and 48 treatment first clients.
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It is not the pedigree or the school that is the mark of success but rather the ability of an individual to use the training and the education. This is something that I have always believed all my life. I have never been intimidated by those who come from private schools and neither have I been intimidated by those who go to conventional high schools. I have been firm in my belief that there is so ...
The researchers wanted to know if the substance abuse differed between the two groups and if the use of treatment for the substance abuse differed. New enrollees at four New York City programs were invited to participate. They had to have a DSM Axis-1 diagnosis. Three in depth interviews were conducted at 0, 6 and 12 months (Padgett, 2010).
Like the first study, this one also found that housing first clients are significantly less likely to use or abuse substances when compared to treatment first clients (Padgett, 2010).
Even those who reported using drugs or alcohol during the study in the housing first program stayed enrolled, while 26 out of 48 in the treatment first program that reported relapsing went AWOL (Padgett, 2010).
Both studies used approximately the same sampling size and technique. Both were in the same geographic area of New York City.
The first study didn’t look specifically at those suffering from addiction like the second study, but comparisons can be drawn between the two studies. Clients in the first study self reported that their substance abuse was lessened by having stable housing before treatment or in tandem with treatment. A weakness in the methodology of the studies would be that the sampling size is too small given the staggering numbers of homeless in this country. From that, it could also be argued that the results cannot be generalized to all homeless individuals. The validity of both studies could also come into question. Instrumentation could be questioned since there was such a large gap between the initial interview and the last interview. Maturation could also play a factor in that some individuals could have just changed over time. Summary
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There isn’t a shortage on research on the effectiveness of housing first programs in the United States or worldwide. The theories presented in this paper are but a sampling of the many available. The problem with studying housing first programs is the lack of empirical large-scale studies of interventions affecting homelessness as a whole. There has not been a large scale reproduction of any study of housing first programs, but with the sun setting of the American Recovery and Reinvestment Act, there is an opportunity to pool the data collected during that ten year time frame and put together a solid body of knowledge on what policies and interventions do the most for alleviating homelessness. The studies presented in this paper are representative of the body of knowledge obtained thus far. Housing first programs have been shown to be effective across this country.
As social workers it would behoove us to research the topic farther because the literature does make clear a very pertinent idea; that when it comes to addressing homelessness in the United States, even as social workers, there is a line drawn between those that are deemed worthy of help, and those who aren’t. Until that idea is addressed and changed in our society as a whole into a more helpful and all-inclusive approach, the studies will just continue.
References
Caton, C. L., Wilkins, C., & Anderson, J. (2007, September).
People who experience long-term homelessness: characteristics and interventions. In Toward Understanding Homelessness: The 2007 National Symposium on Homelessness Research. Chemega, J., & George, C.C. (2014).
Works in Progress: Searching for Solutions to the Difficult Problems of Homelessness. Journal of Poverty, 18(3), 227-230. Henwood, B.F., Stanhope, V., & Padgett, D.K. (2011).
The role of housing: A comparison of front-line provider views in housing first and traditional programs Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 77-85. DOI 10.1007/s10488-010-0303-2 Housing First Works. (2012, March 1).
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What is Coding Theory? “Coding theory is the study of the properties of codes and their fitness for a specific application. Codes are used for data compression, cryptography, error-correction and more recently also for network coding. Codes are studied by various scientific disciplines – such as information theory, electrical engineering, mathematics, and computer science – for the purpose of ...
Retrieved June 25, 2014, from http://www.coloradocoalition.org/!userfiles/Library/HousingFirstFinal.pdf. Neale, J. (1997).
Homelessness and theory reconsidered. Housing Studies,12(1), 47-61. Padgett, D. K., Stanhope, V., Henwood, B. F., & Stefancic, A. (2011).
Substance use outcomes among homeless clients with serious mental illness: Comparing Housing First with treatment first programs. Community Mental Health Journal, 47(2), 227-232. DOI: 10.1007/s10597-009-9283- Parsell, C., Tomaszewski, W., & Phillips, R. (2014).
Exiting Unsheltered Homelessness and Sustaining Housing: A Human Agency Perspective. Social Service Review, 88(2), 295-321. DOI: 10.1086/676318 What is Grounded Theory? – Grounded Theory Online; supporting GT researchers. (2013, December 1).
What is Grounded Theory? – Grounded Theory Online; supporting GT researchers. Retrieved June 26, 2014, from http://www.groundedtheoryonline.com/what-is-grounded-theory
